A Legislative Prescription: How Standardizing Medicaid Can Save Lives
Lara Rahman
“One Nation, Under God, Indivisible, with Liberty and Justice for All” has served as a foundational mantra for the United States and has remained ingrained in American society. One would therefore assume that healthcare coverage would be equal and accessible to all under this patriotic phrase. It is simply a U.S. principle. While the United States has attempted to do so under certain programs, such as Medicaid, many Americans would argue that healthcare access does not align with the nation’s declared ideals.
Medicaid is a joint federal and state program that provides healthcare coverage to low-income Americans who otherwise would not be able to afford private healthcare insurance. The program has grown extensively since its enactment in 1965 by President Lyndon B. Johnson.1 It now includes a much wider range of populations, including low-income families, pregnant women, people with disabilities, and people who need long-term care. One in five Americans, or 72 million people, receive their healthcare coverage through this program.2
Since 2014, the Affordable Care Act (ACA) has provided states the opportunity to expand eligibility for Medicaid to individuals younger than 65 years old with incomes below 133% of the Federal Poverty Level. 4 This was possible through an enhanced federal matching rate. As of 2025, 41 states (including DC) have decided to implement the expansion. 5 The lack of unanimous state support can be attributed to political and financial factors, such as party affiliation and uncertainty around future federal funding commitments. For instance, the majority of states that did not implement the ACA are Southern and Republican-led. Historically, members of the Republican party have viewed the ACA as an overstep into state autonomy, and would much rather have less federal oversight. For these reasons, Medicaid differs from state to state, which makes sense considering the United States’ core value of state autonomy. However, it comes with many consequences: higher uninsured rates, worse healthcare outcomes, and amplified disparities in our healthcare system. Medicaid must be standardized across states because it will lead to improved healthcare outcomes and more simplified administration of healthcare. If the U.S. government does not set standard eligibility and services, patients will continue to be constantly put at risk of losing their healthcare coverage, and our nation’s healthcare system will remain fragmented.
Currently, Medicaid differs amongst states in three main aspects: eligibility, reimbursement rates, and services covered. In terms of eligibility, a substantial difference between states is the work requirement. This means that, in order to receive coverage, an individual must work or volunteer 20–30 hours per week. Exceptions are made for the elderly and pregnant. Another difference amongst state Medicaid programs is the rate that is paid to providers, which is determined by many socio-political factors. Alaska is ranked first for reimbursement rates to providers, which can be attributed to the resources needed to deliver quality healthcare in rural, resource-limited areas. However, it is not always as intuitive as one would imagine. For instance, The Commonwealth Fund stated how “eight of the 10 most populous U.S. states are ranked in the bottom half of Medicaid reimbursement rates.” 6 Another non-intuitive difference is the services that are covered by each program. For example, California covers a wide range of dental care for both adults and children 7 , whereas Delaware will not provide dental coverage after 20 years old. 8
If Medicaid continues to not be standardized, serious consequences on the healthcare status of Americans will follow due to the sole factor of what state they live in. This ultimately boils down to the effects of fragmented healthcare. Providers will face extreme difficulty providing adequate care if their state’s Medicaid rules do not allow for specific services to be financially accessible to the patients. This will change the form of healthcare delivery that affected patients receive, and it may also have an effect on where providers choose to practice. Considering the differences between pay rate and covered services, providers may choose to work in states where both they and their patients are in a more financially sustainable position. Patient populations in states that did not implement ACA are especially affected, as they are likely uninsured. This might delay their delivery of healthcare, which has the potential to worsen health problems over time.
While the US healthcare system is currently set up so that Medicaid differs state to state, there are great benefits in standardizing the program across the country. After all, a standardized program would be more equitable and follow in line with the US mantra of “justice for all” with regards to healthcare access. Furthermore, standardizing Medicaid would simplify healthcare administration. When eligibility and the services covered differ from state to state, it can make it difficult for both patients and providers to achieve quality healthcare outcomes. Consider the case of a patient moving states: this patient might not be able to take the same medications as before due to state-specific policies, and could experience lower healthcare outcomes as a result. A standardized Medicaid would not only have beneficial impacts on healthcare, but also political influence on care coverage. California, a more liberal state, is known to provide the most coverage through Medicaid. On the other hand, Texas, a conservative state, is regarded as one of the most restrictive. By standardizing the program, patients and providers will not have to worry about how their state’s political views impact their access to care.
Some may argue that individual states should continue to play a role in setting their own Medicaid program rules because they understand their patient population best. To illustrate, if a large proportion of a state’s population is elderly, that state might choose to cover certain services like long-term care or home health assistance, which may not be prioritized in other states. In theory, this localized approach seems to be economically efficient and best to serve the patient population at hand. However, in practice, the gap between the healthy, covered patients and the untreated, worsening conditions of non-covered patients grows exponentially. As a result, any overlooked health problems escalate. Resources get shifted to only the largest or most politically influential, and resources are taken away from the smaller or more vulnerable populations. Take dental care, mental health services, and vision care as an example, which select states do not cover for non-pregnant adults over the age of 21. 9 While it may seem sensible on paper to limit these healthcare benefits because they affect a smaller proportion of the population, the consequences are far-reaching. Instead, adults with these untreated health needs will often go without early intervention, leading to the onset or worsening of more serious diseases. This can have effects on broader society: as for the mental health aspect alone, lack of access can lead to higher rates of homelessness, incarceration, and emergency hospitalization. Clearly, disparities in healthcare delivery between states create significant inequalities in healthcare access that are particularly harmful to vulnerable patient populations. Therefore, by standardizing care, we can ensure that these patients receive adequate healthcare no matter which state they live in.
Policymakers in the United States should work towards a standardized Medicaid program that encompasses services and approaches to target all of the unique populations within our country. In doing so, our healthcare system will be less fragmented, and more Americans will be able to receive care that truly aligns with ”Liberty and Justice for All.”
SOURCES
1 History [Internet]. Baltimore (MD): CMS; [cited 2025 February 16]. Available from: www.cms.gov/about-cms/who-we-are/history
2 Total Monthly Medicaid and CHIP Enrollment [Internet]. San Francisco (CA): KFF; [cited 2025 February 16]. Available from: www.kff.org/affordable-care-act/state-indicator/total-monthly-medicaid-and-chip-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
3 Statista. Number of People Covered by Medicaid in the United States from 1990 to 2023 [Internet]. Hamburg: Statista, Inc.; 2024 [cited 2025 February 16]. Available from: www.statista.com/statistics/245344/number-of-people-in-the-us-covered-by-medicaid/
4 Program History [Internet]. Baltimore (MD): Medicaid.gov; [cited 2025 February 16]. Available from: www.medicaid.gov/about-us/program-history/index.html
5 Kaiser Family Foundation. Status of State Medicaid expansion Decisions: Interactive Map [Internet]. San Francisco (CA): KFF; 2025 May 9 [cited 2025 May 20]. Available from: www.kff.org/status-of-state-medicaid-expansion-decisions/
6 Ford TN, Michener J. Medicaid Reimbursement Rates are a Racial Justice Issue [Internet]. New York City (NY): The Commonwealth Fund; 2022 Sep 22 [cited 2025 Feb 16]. Available from: www.commonwealthfund.org/blog/2022/medicaid-reimbursement-rates-are-racial-justice-issue
7 Medi-Cal Dental [Internet]. Sacramento (CA): DHCS; [cited 2025 February 16]. Available from: www.dhcs.ca.gov/services/Pages/MediCalDental.aspx
8 Delaware Dental Care Resource Guide [Internet]. Dover (DE): Delaware Department of Health and Social Services; [cited 2025 May 20]. Available from: https://dhss.delaware.gov/dhss/dph/hsm/files/dentalresourceguide.pdf
[9] Medicaid Benefits [Internet]. San Francisco (CA): KFF; 2023 [cited 2025 May 22]. Available from: https://www.kff.org/medicaid/state-indicator/dental-services/
The Public Health Student Association at Cal State LA, guided by Dr. Evelyn Alvarez, created a Little Free Library to promote climate literacy and encourage reading on campus. The project began after the pandemic disrupted earlier plans for a sustainability film festival. Students and faculty worked together to design and install the library, which features books on climate change, public health, and leisure reading. It was first placed in Simpson Tower and later relocated to the University Library for greater accessibility. Community members can take or donate books, and a survey with a QR code collects feedback to track its impact. The project highlights the importance of adaptability, collaboration, and creative public health interventions that support literacy, environmental awareness, and student engagement.